Ramblings from an ER physician in Singapore.
(This blog is a personal journal. Any views or opinions presented on this website are solely those of the author's and do not necessarily represent those of her organization. No part of this website may be reproduced or quoted without the author's expressed permission, written or otherwise.)

Saturday, August 11, 2007

SighYes, it's been another one of those weeks. Oh wait, make it three.Incapacitating exhaustion. GERD flares. The occasional anxiety about an incident which I'm forbidden to discuss in a public forum. But most of all...An Issue Of TrustA recent email to fellow medical colleagues posing a clinical question unexpectedly turned into a massive effort to discredit the histories provided by 2 patients I saw in the ER.And I suddenly realized how the sacred doctor-patient relationship has eroded beyond repair. As Dr. Gregory House would gleefully proclaim: ALL PATIENTS LIE.The outcry was severe. My willingness to believe my patients' stories was beaten to a bloody pulp. I was accused of maligning our hardworking and often misunderstood general practitioners. It got pretty ugly.The original query is probably now buried deep beneath other grouses, but the lack of trust within the medical profession isn't something we should ignore either, so let's discuss it further.5 Questions for Singaporean Doctors( if you're not from Singapore, please indicate this if you choose to answer )1. Do you agree that the doctor-patient relationship has deteriorated?2. Do you think you can trust your patients: a) >90% of the time b) 75-90% of the time c) 50-75% of the time d) 25-50% of the time, or e) <25%>3. Have you ever been the victim of baseless accusations from a patient and/or patient's relatives? Please supply a few details ( be sure to omit patient and clinic / hospital names ).4. Why do you think this is happening?5. What can local medical professional bodies do to rectify the problem?I obviously don't have statistics on this issue. But drawing from my 8 years in the busy government sector:1. Yes, definitely.2. c3. Too many for comfort. Fortunately, however, I had the benefit of reliable witnesses, good documentation, irrefutable time stamps ( thanks to computerized ER case records which log everything from time of consultation to investigation / treatment orders and dispositions ). One memorable case had an elderly lady's son lodging a nasty complaint against me regarding an incident which occurred during the first day of the MOPEX changeover a few years ago ( during which we saw 400 patients within a 24-hour period ). The patient was stable but already placed in the priority queue and I completed the consultation within a very short period, before asking a nurse to transfer her to the observation ward to await a ward allocation.Her son later arrived at the obs ward and was upset that I didn't speak to him personally, then repeatedly harrassed the nurses to call me over, despite my having my hands full in resus and critical care.Finally, I spoke to him over the phone as I frantically typed notes in yet another patient's case record, apologizing ( yes, APOLOGIZING ) for my absence and attempting to explain the ER situation, but he would have none of it. He wouldn't stop screaming at me and accused me of administering an antibiotic which caused his mother to have chest pain and breathlessness. I informed him that she mentioned nothing of the sort, and that her recent discharge summary never indicated any adverse reactions to any of the powerful antibiotics given to her ( the one I injected was milder by comparison ).Undeterred, he continued to berate me, until I gave up and said, "If you won't believe anything I say, then I'm afraid I can't do anything more to change your mind."A few days later, the complaint arrived. Aside from calling me "rude" and "unfit to be a doctor", he alleged that his mother waited "more than 1 hour" to see the doctor, and waited "more than 30 minutes" for an x-ray. But thanks to computerization, it was clearly shown that I saw her within 9 minutes after triage, ordered the x-ray 15 minutes later, and sent her to the admissions task list 10 minutes after that. ( I still have the complaint and case records to this very day -- that's how POed I am ).He also claimed his mother told him I'm "unattentive and uncompassionate". If only I had video footage of myself holding the vomit bag for her as she coughed and retched into it, and of my ongoing narrative as I explained everything I was doing for her. She even nodded her head and asked questions, for pete's sake! In short, the computer saved my ass.4. Many reasons:Increasing affluence and educational qualifications perhaps, which translate into some form of superiority complex that makes people feel they're entitled to whatever they ask for ( or more often, DEMAND IN LOUD, ATTENTION-SEEKING VOICES ).The media, which encourages public complaints, however inaccurate they may be. ( Best example: the woman who launched a massive Forum Page tirade against the SNEC, only to retract it later and have the Straits Times relay on her behalf that she actually went to a private eye surgeon instead. NO APOLOGY ISSUED. )Sadly, there's the possibility that mistrust of doctors stems from bad experiences with our medical colleagues. I see enough patients who refuse to return to their original hospitals because they hate the staff there. One fellow with a heart attack even told me he didn't consent to an angiogram because "I just didn't trust the cardiologist".5. I posed this problem to one such body in my email, but as I said, it got shredded and the central issue was completely side-tracked. Hence, I have no answer to this question.On A Happier NoteOnly 6 more weeks before I go on MAJOR LONG LEAVE, YES!I've been dreaming of this destination all my life, and have an excellent itinerary lined up, in addition to a detour to the world's greatest emergency medicine conference.More details after I return. :DCool DudesTwo in particular.One's fictional, from the TV series The Closer. There's this FBI agent, Fritz Howard, played by Jon Tenney ( click his name on this page). He's smart, successful and strong-willed, yet fully able to appreciate the idiosyncracies and equally strong mind of his girlfriend, a ballsy LAPD Deputy Chief, no less.Initially a small part, Howard receives an increasing amount of screentime as Season 1 progresses, and earned my first big-smiled "Awww" during an episode where he not only demonstrated some masculine take-charge attitude, but also displayed beautiful chivalry and patience which illustrated his comfortable sense of self-confidence and security. I know a few men like that - they're the best! If only I had the time to hang out with them more often. :)If you have a chance to rent the DVD, please do. Season 2 should be arriving soon.Oh yeah, the second dude. :)Met him yesterday during a stint at the Istana. Naval officer, maybe in his early 40s. Good-looking chap, tall, slim, and one heck of an entertainer.We were treated to a tour of the estate, to help "orientate us in case we're called to attend to someone". He proved to be a most helpful guide, and I was adequately impressed by what I saw ( though nothing quite compares to the grand opulence of the Vatican ).The cheeky teasing was a nice touch. I didn't realize our military personnel were so charming, heh heh!The Saga ContinuesAm two-thirds of the way through Harry Potter & The Deathly Hallows. I don't really like it, but unfortunately, I want to finish the book because - well - I have to. Sorry, I can't stop myself.The plot meanders, the conversations are repetitive, and what's with the Deathstick concoction? Is that an act of desperation on JK Rowling's part? Why not just leave it at The Elder Wand / The Wand of Destiny? Yeesh...Farewell, Bar NoneDon't think I'll feel up to attending the party on August 31st.But I have the best memories of this wonderful little place, which I've visited often with various friends, for various reasons.You've had a good run, guys. I'll miss you.More next time. Wishing you a good week ahead. :)